TY - JOUR
T1 - Catheter ablation of ventricular tachycardia in ischemic cardiomyopathy
T2 - Impact of concomitant amiodarone therapy on short- and long-term clinical outcomes
AU - Di Biase, Luigi
AU - Romero, Jorge
AU - Du, Xianfeng
AU - Mohanty, Sanghamitra
AU - Trivedi, Chintan
AU - Della Rocca, Domenico G.
AU - Patel, Kavisha
AU - Sanchez, Javier
AU - Yang, Ruike
AU - Alviz, Isabella
AU - Mohanty, Prasant
AU - Gianni, Carola
AU - Tarantino, Nicola
AU - Zhang, Xiao Dong
AU - Horton, Rodney
AU - Al-Ahmad, Amin
AU - Lakkireddy, Dhanunjaya
AU - Burkhardt, David J.
AU - Chen, Minglong
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2021 Heart Rhythm Society
PY - 2021/6
Y1 - 2021/6
N2 - Background: Substrate catheter ablation of scar-related ventricular tachycardia (VT) is a widely accepted therapeutic option for patients with ischemic cardiomyopathy (ICM). Objective: The purpose of this study was to investigate whether concomitant amiodarone therapy affects procedural outcomes. Methods: A total of 134 consecutive patients (89% male; age 66 ± 10 years) with ICM undergoing catheter ablation of VT were included in the study. Patients were sorted by amiodarone therapy before ablation. In all patients, a substrate-based catheter ablation (endocardial ± epicardial) in sinus rhythm abolishing all “abnormal” electrograms within the scar was performed. The endpoint of the procedure was VT noninducibility. After the ablation procedure, all antiarrhythmic medications were discontinued. All patients had an implantable cardioverter-defibrillator, and recurrences were analyzed through the device. Results: In 84 patients (63%), the ablation was performed on amiodarone; the remaining 50 patients (37%) were off amiodarone. Patients had comparable baseline characteristics. Mean scar size area was 143.6 ± 44.9 cm2 on amiodarone vs 139.2 ± 36.8 cm2 off amiodarone (P =.56). More radiofrequency time was necessary to achieve noninducibility in the off-amiodarone group compared to the on-amiodarone group (68.1 ± 20.1 minutes vs 51.5 ± 19.7 minutes; P <.001). In addition, due to persistent VT inducibility, more patients in the off-amiodarone group required epicardial ablation than in the on-amiodarone group (13/50 [26%] vs 5/84 [6%], respectively; P <.001). During mean follow-up of 23.9 ± 11.6 months, recurrence of any ventricular arrhythmias off antiarrhythmic drugs was 44% (37/84) in the on-amiodarone group vs 22% (11/50) in the off-amiodarone group (P =.013). Conclusion: Albeit, VT noninducibility after substrate catheter ablation for scar related VT was achieved faster, with less radiofrequency time and less need for epicardial ablation in patients taking amiodarone, these patients had significantly higher VT recurrence at long-term follow-up when this medication was discontinued.
AB - Background: Substrate catheter ablation of scar-related ventricular tachycardia (VT) is a widely accepted therapeutic option for patients with ischemic cardiomyopathy (ICM). Objective: The purpose of this study was to investigate whether concomitant amiodarone therapy affects procedural outcomes. Methods: A total of 134 consecutive patients (89% male; age 66 ± 10 years) with ICM undergoing catheter ablation of VT were included in the study. Patients were sorted by amiodarone therapy before ablation. In all patients, a substrate-based catheter ablation (endocardial ± epicardial) in sinus rhythm abolishing all “abnormal” electrograms within the scar was performed. The endpoint of the procedure was VT noninducibility. After the ablation procedure, all antiarrhythmic medications were discontinued. All patients had an implantable cardioverter-defibrillator, and recurrences were analyzed through the device. Results: In 84 patients (63%), the ablation was performed on amiodarone; the remaining 50 patients (37%) were off amiodarone. Patients had comparable baseline characteristics. Mean scar size area was 143.6 ± 44.9 cm2 on amiodarone vs 139.2 ± 36.8 cm2 off amiodarone (P =.56). More radiofrequency time was necessary to achieve noninducibility in the off-amiodarone group compared to the on-amiodarone group (68.1 ± 20.1 minutes vs 51.5 ± 19.7 minutes; P <.001). In addition, due to persistent VT inducibility, more patients in the off-amiodarone group required epicardial ablation than in the on-amiodarone group (13/50 [26%] vs 5/84 [6%], respectively; P <.001). During mean follow-up of 23.9 ± 11.6 months, recurrence of any ventricular arrhythmias off antiarrhythmic drugs was 44% (37/84) in the on-amiodarone group vs 22% (11/50) in the off-amiodarone group (P =.013). Conclusion: Albeit, VT noninducibility after substrate catheter ablation for scar related VT was achieved faster, with less radiofrequency time and less need for epicardial ablation in patients taking amiodarone, these patients had significantly higher VT recurrence at long-term follow-up when this medication was discontinued.
KW - Amiodarone
KW - Antiarrhythmic drugs
KW - Catheter ablation
KW - Electrical storm
KW - Ischemic cardiomyopathy
KW - Ventricular tachycardia
KW - Ventricular tachycardia storm
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U2 - 10.1016/j.hrthm.2021.02.010
DO - 10.1016/j.hrthm.2021.02.010
M3 - Article
C2 - 33592323
AN - SCOPUS:85106113923
SN - 1547-5271
VL - 18
SP - 885
EP - 893
JO - Heart Rhythm
JF - Heart Rhythm
IS - 6
ER -